Practical, Nonsurgical Solutions for Managing Back Pain

According to a large-scale survey, reported by Georgetown University,¹ nearly 65 million Americans experienced a recent episode of lower back pain. In addition, 16 million cases are chronic. It can affect your routine and can even force you to miss a day’s work. Back pain has indeed become so prevalent that it’s now costing the economy around $2.5 billion a year in health care costs.²

With such a widespread condition, what alternatives are available? Recently, The Conversation published two reports^3,4 covering the dangers of surgery and opioids — two popular procedures for treating chronic back pain — as well as safe, noninvasive methods.

Opioids Exact a Terrible Toll for the Chance of Relief

Opioids are one of the commonly prescribed treatments for Australian adults experiencing lower back pain, especially in areas of socioeconomic disadvantage, as noted by The Conversation.⁵ The close interlink between lower back pain among the economically disadvantaged is further reinforced in a study⁶ published in The Journal of Pain:

“Opioids were the most common prescription pain medication, typically used long-term, in combination with other central nervous system-active agents, and disproportionately among individuals with less than a college education.”

The situation has grown to the point the U.S. Centers for Disease Control and Prevention categorized the ever-growing opioid overdose problem as an epidemic. According to their statistics, opioids have killed almost 645,000 Americans between 1999 and 2021.⁷ To counteract, the U.S. Food and Drug Administration made Narcan, a drug that reverses the fatal effects of an opioid overdose, available over the counter without the need for a prescription.

The Conversation⁸ suggests that in addition to being fatal, opioids may not address the pain at all and may worsen the problem further. In their study,⁹ published in The Lancet, they do not recommend opioids for acute lower back pain, nor neck pain.

According to their findings, participants who took opioids didn’t experience that much relief at all compared to a placebo group.¹⁰ Moreover, other metrics didn’t improve either, such as physical function and time to recover after six weeks of treatment. Side effects such as constipation, nausea and dizziness were also recorded in the opioid group.¹¹

The evidence against opioids is as clear as day, and my stance on the matter has not changed — it’s better to avoid opioids as they’re highly addicting, making them prone to abuse.¹² And with abuse comes the chance for these drugs to be fatal.

The Dark Side of Implanting Spinal Cord Stimulators

When it comes to surgery, the findings are just as concerning. As noted by The Conversation,¹³ one surgical option recommended to patients is spinal cord stimulators. Here’s how they work, according to Johns Hopkins Medicine:¹⁴

“Spinal cord stimulators consist of thin wires (the electrodes) and a small, pacemaker-like battery pack (the generator). The electrodes are placed between the spinal cord and the vertebrae (the epidural space), and the generator is placed under the skin, usually near the buttocks or abdomen.

Spinal cord stimulators allow patients to send the electrical impulses using a remote control when they feel pain. Both the remote control and its antenna are outside the body.”

But are these devices effective? Going by published research, the results aren’t convincing. In a 2023 Cochrane meta-analysis¹⁵ that covered 13 studies with a total of 699 participants, the authors did not recommend this device, as it “probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.”

The Conversation article¹⁶ also cites a review reported to the Therapeutic Goods Administration of Australia,¹⁷ which found 520 adverse events between 2012 and 2019 related to spinal cord stimulation. The review findings indicated that 79% of these events were categorized as “severe,” while 13% were “life-threatening.”

The devices can also malfunction, which isn’t reassuring, especially when you consider the price. According to a 2022 study, the procedure can cost anywhere between $15,000 and $50,000.¹⁸ In addition, complications such as bleeding and infection may occur. Sometimes, the device doesn’t even work as intended, which can necessitate another surgery for correction.¹⁹

The Conversation also highlighted another alarming risk of spinal cord stimulators from an episode of ABC Four Corners titled “Pain Factory.”²⁰ The show²¹ tells the story of Teresa Burbery, who had been dealing with chronic pain due to an accident and agreed to having a spinal cord stimulator implanted, thinking it may help ease her condition.

Unfortunately, during the operation, the surgeon struck Teresa’s spinal cord, paralyzing one of her legs. In what was supposed to be an overnight procedure only, she had to be hospitalized for an additional six weeks for recovery.

Spinal Fusion Surgery — Another Option Not Worth the Risk

Aside from spinal cord stimulators, another invasive option highlighted by The Conversation²² is spinal fusion surgery. It’s a process wherein two or more vertebrae in the spine are joined together, locking movement between them. To do this, a surgeon may apply strips of bone graft on the affected part of the spine or between the vertebrae.²³

But spinal fusion surgery is just as ineffective. In a retrospective cohort study²⁴ published in BMC Health Services Research involving 9,343 participants, only 19% were able to return to work at full capacity. Another 19% had to return to the hospital for another surgery, with some of them having to go back five times.

With such high risks involved, opioids and surgery are clearly out of the equation. It would be wise to resort to safe, noninvasive methods instead, which target the root cause of lower back pain, allowing you to enjoy life without depending on life-threatening interventions.

Rooting Out the Cause of Lower Back Pain — Lack of Movement

If you’re suffering from chronic lower back pain, logic might dictate that you should avoid exercise until the pain subsides. After all, it seems odd to physically exert yourself if you have a bad back. However, gentle exercise is one of the best ways to address pain.

If you’re also sitting down for long periods of time, you won’t be addressing the pain — being sedentary may actually worsen it. To stop the condition from deteriorating further, I recommend avoiding sitting for prolonged periods and to stand whenever you can. In fact, foregoing sitting and choosing to stand helped me heal my own chronic back pain.

According to a study²⁵ published in Frontiers in Public Health, sedentary employees increase their risk of physical conditions, most notably back pain. A sedentary lifestyle can also be detrimental to mental health, which can lead to a negative cycle affecting productivity. Again, one way to effectively improve your back is to increase your physical movement.

A meta-analysis²⁶ of 21 studies confirmed that not only is exercise the most effective way to prevent back pain from happening in the first place, it’s also the best way to prevent a relapse. Among people who had a history of back pain, those who exercised had a 25% to 40% lower risk of having another episode within a year than those who did not exercise.

But if you’re still feeling apprehensive about exercising, there are strategies to help you reconsider and help you go back to becoming more physically active.

Exploring the Psychological Component of Pain

Is pain all in your head? Based on published evidence, the mind is just as important as the body in recovering from lower back pain. Going back to The Conversation’s report,²⁷ they highlighted the RESTORE trial, a 2023 study²⁸ that investigated the cognitive aspect of pain management in people suffering from lower back pain.

During the study,²⁹ they had participants undergo cognitive functional therapy (CFT), which is “an individualized approach that targets unhelpful pain-related cognitions, emotions and behaviors that contribute to pain and disability.” To give you an idea on how CFT works, here’s a succinct explanation, provided by The Conversation:

“The therapy helps the person understand the unique contributing factors related to their condition, and that pain is usually not an accurate sign of damage. It guides patients to relearn how to move and build confidence in their back, without over-protecting it. It also addresses other factors such as sleep, relaxation, work restrictions and engaging in physical activity based on the person’s preferences.”

By the end of the study, the researchers concluded that CFT was a helpful tool in helping improve lower back pain, compared to groups who received standard care only.³⁰

There’s some research supporting the hypothesis explored in the RESTORE study. In a paper published in Physical Therapy,³¹ researchers stated that pain intensity is not just caused by an external event, your psyche (such as prior experiences and beliefs) come into play. As such, the perception may explain why certain people with lower back pain explain their lack of motivation to exercise — they think that exercising can exacerbate the pain further.

Address the Mental Component of Pain With EFT

If you’re having any negative thoughts that are preventing you from exercising due to the fear of worsening your lower back pain, I recommend the Emotional Freedom Techniques (EFT). It’s a drug-free approach for pain management of all kinds.

EFT borrows from the principles of acupuncture in that it helps you balance out your subtle energy system. It helps resolve underlying, often subconscious, and negative emotions that may be exacerbating your physical pain.

By stimulating (tapping) well-established acupuncture points with your fingertips, you rebalance your energy system, which tends to dissipate pain. Once you integrate EFT into your health routine, you’ll be more motivated to try exercises that can help address back pain.

Build a Strong Base With Foundation Training

Foundation Training, created by Dr. Eric Goodman, are specific exercises that work to gradually pull your body out of the movement patterns hurting you. Its philosophy focuses on strengthening your core, which includes anything that directly connects to your pelvis, whether above or below it.

One exercise you can try is compression breathing. It’s an important aspect of Foundation Training, as it can help re-educate the muscles surrounding your axial skeleton (the spine of your rib cage), teaching them to be in a state of expansion rather than contraction.

Done properly, it will help lengthen your hip flexors, stabilize your spine and support your core using transverse abdominal muscles. This strengthens your back and keeps your chest high and open:

1. Whether sitting down or standing, put your thumbs at the base of your rib cage, positioning your pinkies at the pointy bones at the front of your waist. Think of the space between your fingers as a measuring stick.
2. Pull your chin back so your chest is lifting upward. Take three slow deep breaths as instructed in the video below.
3. The distance between your thumbs and pinkies should increase as you breathe in.
4. When you breathe out, tighten your abdominal muscles so your torso will not collapse back down. This is the most important step — Do not let your torso drop back down toward the pelvis as you exhale. It should be challenging, allowing you to feel your abdomen engage as you exhale.
5. With each breath, your aim is to increase the distance between your thumb and pinky fingers, as well as increase the width of your upper back. This occurs as you elongate the back of your rib cage.

Each inhalation expands your rib cage, and each exhalation will keep the abdomen extended and tight. So, each in-breath fills up your rib cage, and each out-breath maintains the height and width of your rib cage.

Repeat five to 10 rounds with three to four breaths per round. Over time, your muscles will get stronger and your seated posture will gradually improve. You’ll find a demonstration of this technique in the video below.

If you want to integrate more Foundational Training exercises into your health regimen, you can find a certified trainer in your local area through the official website.

Additional Strategies That Can Help Relieve Back Pain

While addressing the physical and mental component of lower back pain management is important, you can improve your outcomes further by adopting other healthy habits. For additional strategies, I recommend you visit, “Is Most Back Pain Caused by Repressed Emotions?” There, I provide an extensive list of dietary recommendations and supplements that may help address back pain.

Aside from compression breathing, you can try these seven exercises³² from the Mayo Clinic, which are designed to help strengthen your back. Choose one and do it for around 15 minutes. Be sure to go easy at first, repeating the exercise several times. As your back gets stronger, you can increase the duration.